Read the case study then answer the following questions:

S.E. is a 24-year-old graphics designer who suffered multiple fractures when she fell from a cliff while hiking.
She has been in the hospital for 2 weeks and has no appetite. She weighed 63.5 Kg upon her arrival in the
hospital, but she has lost 4 Kg over the course of her hospitalization. Due to the nature of her injuries, she is in
traction and is immobile, although the head of her bed can be elevated 45 degrees. From the diet history, it
appears that her nutrition status was adequate before hospitalization. The health care team agrees that naso-
duodenal tube feeding should be instituted before her nutrition status deteriorates further. The standard formula
selected for the feeding is lactose-free, and nutrient requirements can be met with 2200 milliliters of the formula
per day.
1. What steps can be taken to prepare her for tube feeding? What are some general reasons why nasoduodenal
placement of the feeding tube might be preferred over nasogastric placement?
2. What parameters should be monitored to ensure that her fluid needs are being met? How can additional
fluids be given? Estimate her fluid needs using her current weight and the fluid intake range.
3. The physician’s orders specify that the feeding should be given continuously over 18 hours, determine an
appropriate feeding rate.
4. What steps can the health care team take to prevent aspiration? Describe precautions that should be taken if
the patient is to receive medications through the feeding tube.
5. After three days of feeding, the patient develops diarrhea. Determine possible causes. What measures can be
taken to correct the diarrhea?
6. After a week, the patient started tolerating soft jelly like options, suggest a meal that consists of three food
options that you would offer the patient on such diet.